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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1367787



Case Details

VAERS ID: 1367787 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Immediate post-injection reaction, Incoherent, Pallor
SMQs:, Anticholinergic syndrome (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: nka
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient received first covid 19 shot on 6/1 immediately had a rxn of turning very pale, clamy, dizzy, and was incoherent off and on. She never fully lost consciousness however we called 911 and she was checked out by emt. Mother reported she was filling better later in the day


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